Virginia Commonwealth University VCU Scholars Compass

Theses and Dissertations Graduate School

2014

Dr. WHO?: The Science and Culture of Medical Wear Design

Patricia Duignan Virginia Commonwealth University

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This Thesis is brought to you for free and open access by the Graduate School at VCU Scholars Compass. It has been accepted for inclusion in Theses and Dissertations by an authorized administrator of VCU Scholars Compass. For more information, please contact [email protected]. DR. WHO? The Science and Culture of Medical Wear Design

Patricia Duignan

Dr. WHO?: The Science and Culture of Medical Wear Design

A thesis submitted in partial fulfillment of the requirements for the degree of Master of Fine Arts at Virginia Commonwealth University

by Patricia Duignan B.DES in , National College of Art & Design, Dublin, Ireland, May 1994.

Thomas Modeen Acting Director, MFA Design Studies

MFA Thesis 16 June 2015 Peter S Chomowicz Thomas Modeen Primary Advisor Acting Director of Graduate Studies Associate Dean for Research and Development Virginia Commonwealth University in Qatar Virginia Commonwealth University in Qatar

Paolo Cardini Allyson Vanstone Secondary Advisor Dean Associate Professor Virginia Commonwealth University in Qatar Rhode Island School of Design (RISD)

Jesse G Ulmer Dr. F. Douglas Boudinot Reader Dean, School of Graduate Studies Assistant Professor, Liberal Arts and Science Virginia Commonwealth University Virginia Commonwealth University in Qatar CONTENTS

ACKNOWLEDGEMENTS 2 ABSTRACT 4 INTRODUCTION 6 Background 7 DESIGN PROCESS 10 The Lab and Symbolic Representation 11 Development of Historical Symbolism 13 Psychological Dynamics of the Lab Coat 17 Summary 18 INVESTIGATION I 20

PRODUCT PRECEDENTS ANALYSIS 28 Investigation I 29 Investigation III 30 Investigation IV 33 Investigation V 36 Analysis 42

HOSPITAL SYSTEM 44 Healthcare Associated Infections (HAIs) 45 DESIGN PROCESS 46 Enclothed Cognition 48 Design 50 Future Scenario I 51 Future Scenario II 53 Design Innovation 59

EXHIBITION 61 CONCLUSION 65 END NOTES 67 TABLE OF FIGURES 70 BIBLIOGRAPHY 72 I ACRONYMS AND ABBREVIATIONS 74 II DEFINITION OF TERMS 74 Thank you to all the wonderful people who helped me along this path. …my husband Matthew for his continued love and support and most of all taking up the slack with the kids. …my gorgeous children Arabella and Oisin for their humor, laughter and putting up with an absent mummy. …my friend Sandy Wilkins for endless support and words of wisdom. …my friend Byrad Yelland for his guidance, helping shape my thesis into a proper academic piece of work. …my colleague Catherine Chiuco for wonderful collaboration and beautiful design of my thesis book. …my friend Rob Valenta and his team at Quantum Media for collaborating and producing my slick video. …my helpers Narita Mattock, Abdul Cader for guidance and reminding me of fashion skills I had not used in a long while. …my colleague, fellow student and friend Hadeer Omar for assisting in video creation, constant advice and guidance along the way. …my models, Margarita, Sheika, Maryam, Rabab, Samia who graciously volunteered and gave up their time to model in my video …my advisors Paolo Cardini, Jesse Ulmer for their belief, support and advise. …my primary advisor Peter Chomowicz for the continued support and pushing me to think in ways I otherwise would not have. ABSTRACT

The multi-million-dollar medical industry has not utilized medical, functional, cultural and symbolic roles of the lab coat within advancements in garment and textile technology that could positively the hospital environment and beyond, to the larger the global society. impact the protection of healthcare professionals and patients. In This thesis examines the extent to which the design of medical wear most cases the meet basic requirements – they clothe can impact the effect of hospital-acquired infections, support doctor/ the professional in a recognizable way. Little innovation in design, patient relationships and enhance the and behavior of function and performance, has been applied to these garments. This the healthcare professional by envisioning a future lab coat which THE MEDICAL is particularly evident in the case of the stereotypical white lab coat which offers increased protection for physician and patient, aids in worn by many physicians, despite evidence indicating that these lab communication and enhances the performance of the doctor by utilizing may carry contamination and play a role in the spread of deadly digital technologies incorporated into the lab coat whereby the lab coat bacteria. Healthcare Associated Infections (HAIs) are among the becomes the only tool necessary for the physician. UNIFORM most serious problems facing modern medical care, costing millions of lives and dollars annually worldwide. This research investigates the design and use of the physician’s lab coat – an immediately recognizable symbol of Western . The research identifies the

04 INTRODUCTION

As principal investigator of a large-scale project to design the clinical working with the same materials and textile makers who produce cloth wear uniforms for the new Sidra Medical and Research Center in consistently year after year. Having served both as an in-house fashion Qatar, I discovered that the field of medical uniforms is characterized designer at a garment manufacturer and as a client, I am aware of the by a lack of innovation almost unheard of in the fashion industry. commercial limitations placed on designers. In the commercial world Much of the literature on medical uniforms focuses on the policies, garment cost is the bottom line, and if a design threatens profits it is symbolism of uniforms and is undertaken by standards authorities and typically either disregarded or is stripped of its expensive components the medical profession.1 In contrast the research carried out by uniform to achieve the price target. Price targets are dictated by previous selling manufacturers is lacking; and what design-based research there is, has prices and competitor prices. All of these factors combine to create typically been developed with only minimal input from the people who a heavily standardized market of commercial designs. The aim of will wear the end product.2 Within the design industry, professional this research is to creatively investigate design options for a medical garments such as medical uniforms are designed to accommodate uniform, in this case the physician’s lab coat, and develop a conceptual the existing manufacturing capabilities of the producer, which can prototype that will break free of the bonds of market standardization to limit a critical design approach and innovation.3 One consequence of present a garment that is designed to assist physicians in carrying out PREFACE this is the lack of focus on garment performance, resulting in a classic all aspects of their role. Data for this research was collected through a fashion approach offering seasonal product updates that have minimal triangulation of personal observation, interview and document review aesthetic variations, typically changes only in color and simple with informants medical professionals, administrators, textile engineers styling details. Manufacturers tend to stick to tried and tested fabrics, and garment manufacturers.

06 BACKGROUND

The physician’s lab coat and has been the subject of much followed by 23% stating the need to carry medical instruments, and debate. The “bare below the elbow policy” (BBE) was introduced 15% stated to keep their clothes underneath clean. However, when by the UK’s Department of Health in 2007 to tackle nosocomial assessing the results, it is important to note that only 29% of the study infection, and banned the wearing of wristwatches, , and population actually wore the white lab coat (82% of the doctors were long sleeves for clinicians. However, the same research found that working in pediatrics and psychiatry). Reasons for not wearing the coat physician’s neckties are worn repeatedly and rarely cleaned; making included avoiding a negative impact on patients. Interestingly, research them the perfect substrate to carry bacteria from patient to patient as suggests that even with the decline of popularity in wearing the white physicians go about their rounds. , moreover, are susceptible coat among physicians, it is still desired by many patients. In another to contamination for the same reasons. In addition, long sleeves study, 56% of patients favored doctors wearing white lab coats.8 Similar were deemed a hindrance to the vital exercise of hand washing. results were obtained during a study of 168 patients from three teaching However, C. A. Willis-Owen, et al carried out research in 2009 family medicine clinics in Israel, in which 52% of the patients preferred to examine the effect of the policy on the presence of bacteria on a physician in a white lab coat because it signaled a trustworthy doctors’ hands and concluded that there was no significant difference profession.8 It is evident that there are inconsistent theories for or against between the presence of bacteria on the hands of the doctors who the use of the lab coat, it is clear that there are personal and professional were compliant with the policy and those who were not.4 However, preferences which influence the decision making however if a lab coat is other research has found that what doctors’ wear has an important worn, it should function in ways that support both the doctor and patient, psychological effect on patients. Subramanian, et al, demonstrated offering protection, comfort, and reassurance to both parties. that patients perceive the BBE-compliant uniforms as unhygienic; thus, the patients’ confidence in the doctor may be undermined. What doctors wear can influence a patient’s perception of the clinician, which in turn may influence whether patients follow a doctor’s advice. Figure 1 Mind map of lab coat stakeholders, VCUQatar, Al Rayyan, Qatar (2014) Formal attire has been shown to instill greater confidence and trust in DESIGN PROCESS patients. Questions have arisen as to whether a doctor’s clothing can impact the patients’ decision to attend follow-up consultations and situation, identifying the views of all participants, the issues which Main Topics of Investigation 5 concern them and the invention that will serve as a working hypothesis consume medicine as prescribed. However, C. A. Willis-Owen, et al, A system such as the medical garment industry has a long and argue that the findings, which led to the legislation are flawed and for exploration and development”.10 conventional history including multiple stakeholders. The complexity Symbolism meanings and definitions they recommended that more critical research be done, including an 01 of this system requires cognizance of many disparate perspectives communicated by the product In this research I used design thinking to gain a deeper understanding of examination of the uniforms and as a source of contamination. and agendas when approaching the design of a product such as the subject matter in order to determine the feasibility of changing the the physician’s lab coat because the garment is a symbol of this design of the medical uniform. More specifically, I analyzed problems The popularity of the white lab coat has actually decreased system and is therefore deeply embedded in history and meanings significantly since its adoption in the early 1900s. In 1991, studies in related to the current uniform and examined the background and history Product physicality of the garment determined by the system. In order to work my way through this 02 of the physician’s uniform to identify common dominators and factors to the United States indicated that more than 70% of hospital doctors conceptually I used a mind map to arrive at three main topics 6 be addressed in the redesign of the lab coat. and medical students wore a more than 75% of the time. for investigation, each of which links to multiple subtopics and More recently a 2004 study indicated a large reduction in the number stakeholder groups for consideration. These areas of investigation are of physicians who chose to wear a white coat at only 13% of the presented below. These topics have become the subject matter for User physicians 7 03 physicians in the study. The studies indicate that the main reasons the body of my thesis research. I then applied design thinking to work for this change included infection risk, discomfort, and interference with this information. See Figure 1 in the physician-patient relationship. In 1991, 294 medical students and physicians in London were asked to explain why they wear the Buchanan, a widely recognized professor at the Carnegie Mellon Hospital systems lab coat on the basis of personal priorities. The responses of 25% University School of Design, describes design thinking as a process, 04 of respondents stated easy recognition by colleagues and patients “by which a designer intuitively or deliberatively shapes a design

07 08 DESIGN PROCESS THE LAB COAT AND THE SYMBOLIC PRESENTATION

A question that continually arose as I began to understand more about the role of the doctor’s uniform was: how much change could I make to the lab coat without eroding its benefits to physicians, patients and society as a whole in terms of its status as an internationally recognized symbol? This led me to question why and how the lab coat has become one of the most recognized symbols of medical doctors? I realized that I needed to examine my subject matter in terms that reached beyond materiality to understand the uniform from a more holistic perspective.

The impact of clinical wear symbolism is readily apparent in the physician-patient interaction. The physician-patient relationship is the foundation for all medical care. Research suggests that a patient’s initial consultation plays a fundamental role in the development of this relationship.11 During this consultation, the patient will develop a first impression of the physician based on a number of factors including the physician’s verbal and non-verbal communication as well as personal attributes such as clothing, accessories, grooming, and cleanliness.12 As far back as the 400s BC, the ancient Greek physician Hippocrates recommended that doctors should “be clean in person, well dressed, and anointed with sweet smelling agents.”13 Hippocrates’s prescription suggests that how a doctor looks (and smells) has been important at least since the dawn of Occidental medicine.

D. W. Cathwell, MD, wrote the first edition of The Physician Himself, a book to guide doctors in all aspects of their role as physicians entering the medical profession. The first edition of the book was written in 1882 and revised with multiple editions published between 1882 and 1922. Cathwell advised, “Show aesthetic cultivation Figure 3 Eakins, Thomas. “Agnew Clinic”, Oil on canvas, 2.14 m x 3.0 m depicting Dr. Agnew in surgery carried out in white clothes 1889. in your office arrangement, and make it look fresh, neat, clean Figure 2 Eakins, Thomas. “The Gross Clinic”, Oil on canvas, 240 cm × 200 and scientific.”14 Even at the earliest understanding of the doctor’s cm Surgery carried out by Dr. Samuel dressed in black layman’s clothes, 1875. profession, it was clear that not only were the physician’s physical a garment to protect the wearer from various forms of dirt and performed. Following the discovery and proof of germ theory, a major appearance and attire important, but also the state of his/her bodily fluids encountered during certain procedures.15 It is believed force in adopting the white coat, which has since become synonymous surroundings, each shaping social interaction in a distinctive manner. in their homes, not in an institution. During this period, there was no black was used in recognition of the somber nature of the work with the medical profession, was the shift in sick care from home to Multiple factors influence patients’ perception, which promote a understanding of the concept of bacteria and its role in the spread of carried out. Louis Pasteur, the French chemist and microbiologist, hospital. This occurred because it became too difficult to create a sterile relationship of trust between doctor and patient. infection. Doctors’ status, as it is today, did not exist prior to the 19th proved the germ theory in the mid-1800s, which led Joseph environment outside the hospital and was impractical to bring the century, when doctors were mostly indistinguishable from other types Lister to develop antiseptic methods in surgery, a major scientific necessary equipment into peoples’ homes. Therefore, hospitals began The color white has not always been the obvious choice for the of healers with their various forms of rituals and . To become development that revolutionized medical care.16 The white lab coat to adopt the color white for all uniforms related to healing during the lab coat. In fact, doctors didn’t even wear lab coats in the 19th a doctor was relatively easy; a medical degree could be obtained in was introduced into the operating theater to protect the patient from early 1900’s. During this period, medical schools also adopted a more century. The doctor’s dress at that time consisted of formal attire a year. Scientists in laboratories wore tan colored lab coats to make being contaminated by the physician and to protect the physician rigorous and standardized curriculum and physicians became scientific for all clinical activity, including surgery. Doctors attended the sick dust more visible, and black lab coats were worn in mortuaries as from being contaminated by the patient while surgery was being in their practice and dress.

11 12 DEVELOPMENT OF HISTORICAL SYMBOLISM

a sign of having proved worthiness to enter the group or rank that a white coat ceremony (WCC), a ritual signifying the right of passage goes with the uniforms for example the nurse’s pin, the policeman’s into the medical profession. D. W. Blumahagen and others have shield, army stripes, soldier’s honorary medals, academic and identified cultural symbols as a form of communication, analogues lawyer’s wigs. Rituals include the graduation ceremony, which formally to spoken words in a natural language.18 In fact, words are symbols. acknowledges admission into an elite group and acceptance of what The word “chair” is not a chair, it is a symbol used to represent a chair the group stands for. More than 100 medical schools in the US mark during communication. Symbols are developed in congruence with the the transition from medical student to a qualified physician by holding definitions and meanings held by a social group whether it be a small

Figure 4 “Trust” Mind map, pen on paper, 2014.

Just as the social function of the physician has evolved over the past Dr. Byrad Yyelland, sociologist and Assistant Professor at VCUQatar, century, so has the lab coat. The color white commonly symbolizes explained that a uniform acts on a number of levels. The existence of a cleanliness, purity, and the scientific foundation of the medical uniform implies a group structure. The uniform indicates membership profession. Science, with its ability to defy common beliefs and advance in the group, which represents and embodies the attributes of an the world in ways not previously seen or thought of, became the basis of organization. The white lab coat therefore acts as a symbol.17 Admission the medical profession at the turn of the 20th century when the benefits to a group can be symbolically recognized during ceremonies when of sanitation and clean water were recognized in conjunction with the the uniform and its accessories are presented to the newly qualified introduction of the antiseptic theory. professional. In many professions, these symbols are recognized as Figure 5 George Clooney, TV series ER Figure 6 Patrick Dempsy, TV series Greys Anatomy

13 14 Figure 7 Ellen Pomeo, TV series Greys Anatomy Figure 8 Doctor Characters, TV series Grey’s Anatomy

clique or a larger society. As such, symbols express and reaffirm and scripted ways. Symbols such as uniforms also enable others in the Boy Scouts)”.23 Symbols are tools for expressing and reaffirming instance, the lab coat served to legitimize behavior that was otherwise the fundamental belief systems of that group.19 The white lab society (audience) to understand what they can expect from the actor fundamental belief systems of a society. Studies have examined considered socially taboo. With this, a message of power and coat is symbolically associated with the definition of physician in that role. In other words, seeing someone wearing a white lab coat in symbols commonly deployed to represent the doctor and have protection emerged and physicians quickly became stereotyped as in Western-based medicine and, in fact, is the most frequently medical setting signals to us that this person is a medical professional, identified four defining objects: the white lab coat, stethoscope, head scientists wearing white coats.26 used object when representing a physician in a variety of media likely a physician, and we can expect certain types of behaviors from mirror and black bag. Of all the symbols identified, the white lab coat including advertising and film.20 that person.21 In this social drama, the uniform or can also was found in use most frequently.24 Importance of the white lab coat The trend continued on in the 90’s, George Clooney became one of express hierarchical relationships amongst the individuals who are as symbol par excellence of doctors can be seen in a variety of media the most popular and recognized actors due to his role as a physician Dr. Yyelland explained that in dramaturgical sociology, one could interacting. But why have these symbols relating to doctors become so including advertising and film, which often reflect social stereotypes. in the popular U.S. medical drama ER. and House are two consider the elements of human interactions as dependent upon prevalent and powerful?22 As far back as the early 1900’s the emerging film industry began to other current popular television series that are aired internationally time, place, and audience. In the same way language is used represent physicians as characters of immense power.25 The doctors and portray doctors as central characters. Physician’s characters in in a social setting to define a shared interpretation of reality, the “Symbols are social objects used to represent (or “stand in for,” “take eventually achieved a god-like social status as a result of the surgeon’s television series are usually portrayed wearing a white lab coats worn uniform assists the wearer in an actor-like fashion to be seen as a the place of”) whatever people agree they shall represent…holding power to anesthetize the patient and carry out procedures that in any over their clothes underneath. See Figure 5 and 8 character playing a role and therefore behaving in pre-determined two fingers in the air stands for victory (or peace, or loyalty to the other circumstances would be deemed as violating the body. In this

15 16 parents of children admitted to a pediatric ward of a university teaching hospital in America discovered that they were twice as likely to attribute confidence to doctors in formal clothing compared to doctors in casual PSYCHOLOGICAL DYNAMICS dress.30 In a similar study 76.3% of the 400 respondents said they preferred the use of a white lab coat.31 Interestingly, patient trust and OF THE LAB COAT confidence were significantly linked to their preference for professional dress. On this very point, Dr. Guy Brisseau Chief of Pediatrics in Sidra Hospital in Qatar reflected on his time teaching trainee doctors and remarked that sometimes they would arrive to class wearing casual So why is it so important that the doctor be recognized as such by J. P. Kriss, a physician and educator, articulated the need for appropriate and t-. He considered this as inappropriate attire and he sent his or her patients? In the article, “ The doctor’s white coat,” D. W. physician’ attire in the article “On White Coats and Other Matters”, offending students home to change into more professional clothing Blumahagen explains that the relationship between patient and doctor is explaining, “The physician’s dress should convey to even his most that more aptly projected the doctor’s professional image.32 However, 27 “serious and purposeful, not social, casual or random.” A patient must anxious patient a sense of seriousness and purpose that helps to provide research has also highlighted that there are discrepancies between bare himself or herself in front of a doctor in a deeply vulnerable way. reassurance and confidence that his or her complaints will be dealt with patients’ perception and signification of the lab coat and the reasons 28 This type of situation does not exist in any other form of communication competently.” Confidence in one’s physician is crucial because the doctors choose to wear or not wear one. . Many culturally progressive or experience. In many disciplines formal attire is worn for serious medical process requires patients to share intimate knowledge about Western psychiatrists and pediatric doctors, tend not to wear the lab business in the same way casual attire is often worn for less serious themselves in order to receive treatment. This process can also require coat, reporting that it inhibits the relationship between patient and business or leisure time. the patient to bare all or part of the body to the physician and allow the doctor because it may intimidate the patient. In this context, doctors often choose to wear pastel coats or normal clothing. Another factor in patient preference for formal attire is age. In a study to assess patients’ preferences, patients over the age of 40 preferred doctors’ formal attire, Figure 10,11 “Trust Fall” Sequential storyboards, pencil on paper, 2014. whereas younger patients were less concerned. Interestingly, the preference for more conservative apparel is age-related for doctors as well as patients. Doctors in more senior positions and over the age of physician to observe, touch, and even cut into the patient’s physical 40 prefer more conservative, traditional dress. However, this trend is self, all of which are intensely intimate acts.29 On the other hand, the a predictable reflection of the normal behavioral shift associated with physician is required to ask questions about intimate topics, observe ageing rather than the specific phenomenon related to the doctors’ parts or all of the patient’s body and perform medical procedures appearance. Some studies show that patients actually felt more relaxed upon the patient’s body. All of these acts are profoundly intimate at a about the appearance of physicians than the physicians themselves.33 physical level yet must occur while maintaining an emotional distance. There is a significant difference of opinion surrounding the discussion This inherently contradictory relationship places both parties into some of doctor’s attire, with the lab coat tending to occupy the focus of degree of vulnerability, enhancing the need for a strong feeling of trust. much discourse. The current lab coat offer in the market is lacking in a number of areas including aesthetic, performance and functionality. Many studies have examined the perceptual effect the doctor’s This research also suggests that there is not one solution that will appearance has on the patient and have confirmed that patients do care all cases; there is a need for a flexible uniform option that supports the about the appearance of their doctor. It has been shown that patients individual needs of the doctor and the expectation of the patients he/she may unconsciously evaluate the doctor’s competency and credibility attends. This thesis will present an alternative that meets the needs of on the basis of how the physician’s physical appearance. A study of the physician and patient. SUMMARY

As my research strongly suggests, the white lab coat has become a wanted to examine trust in a raw state, in its most basic and primitive powerful and pervasive symbol of trust in society in general and the form in order to visualize the feeling. The situation needed to be one in medical profession in particular. To further my understanding of trust, which the risk was not too high but also gave me the opportunity to see I staged a scenario to observe trust in action during my studio class. how the participants would assess risk in a particular situation. There are Intentionally, I avoided grounded theories relating to trust in terms of risk particular conditions needed for trust to exist. Figure 9 “Trust” Mind map, pen on paper, 2014. versus gain and the relationship between the principal and the agent. I

17 18 INVESTIGATION INVESTIGATION I

Figure 13 Studio set up Figure 14 Studio set up

After brainstorming a number of ideas, I decided upon the classic trust Criteria: fall that is commonly used as an exercise in team building. Research confirmed that many of the conditions that promote trust include familiarity, understanding, recognition, repetition, and knowledge. In 01 No Intsruction 04 No Prior Knowledge short, people trust what they know. With this in mind, my intention was to engineer a scenario in a way that could eliminate some of the conditions associated with trust as part of the experiment so that I could examine the situation and further understand the human condition in relation to trust. 02 No Demonstration 05 No Familiarity

I designed the scenario in detail with the subjects’ positions clearly marked, cameras poised, and a practice run conducted with Hadeer Omar, a graphic designer who kindly assisted me in setting up, 03 No Discussion 06 No Repetition editing the video, and being a volunteer herself. See Figure 14. Figure 12 Studio set up

21 22 Figure 15 Trust Fall Figure 17 Trust Fall

Figure 16 Trust Fall Figure 18 Trust Fall

23 24 I chose seven volunteers, all of whom were female VCUQatar students continuous scene for each couple, but due to the variety of camera who wear the Abaya a black piece of clothing that is commonly worn shots required, in reality we shot two to three times to get enough to hide the clothing underneath). See figure 15-20. This choice was footage. Originally, I felt this would make the video look contrived made to include volunteers of the same sex, of similar status, religious and inauthentic, resulting in the scenario looking rehearsed, but in and cultural values. Mixing the sexes in an exercise such as this would fact it actually displayed the importance of repetition, one of the main not have been appropriate within the Islamic culture. Some of the characteristics involved in forming trust. It was clear from talking to the volunteers already knew each other. In fact, recruiting the volunteers participants that they felt more comfortable assuming the risk with each worked better when the two (catcher and faller) were recruited together. additional fall. This is evident in the facial expressions of the participants. This confirmed research that indicates familiarity could promote a sense Another interesting aspect I had not considered was the emotions of of trust. Knowing the person who was catching you indeed helped in the catcher. One volunteer stated she felt far more nervous catching easing the anxiety of the fall. One volunteer pointedly remarked how somebody due to the responsibility she felt to the other person, feeling she was glad she knew her catcher.34 In the case of a physician meeting less nervous when she was actually doing the fall herself. See Figure a patient for the first time there is no prior knowledge and makes it even 20. This demonstrates the concept of responsibility and the feWelings more important that the appropriate conditions exist that help support associated with it are very powerful. trust in the relationship including what the physician is wearing. Figure 19 Trust Fall The outcome of the experiment provided first hand knowledge of trust To capture specific angles and details on camera including facial but also insight into the relationship between two people. The scenario, expressions, gestures and actions, some instruction was required. On in a way, metaphorically represents the doctor-patient relationship, the one hand, I had to direct the couple, and on the other, the couple where the patient trusts the doctor by literally putting themselves in their needed to interact naturally by asking questions and discussing things hands. It begs the question that if the lab coat is used as a symbol to between themselves about how the action would play out and what represent trustworthiness, and in so doing acts as a tool to facilitate and each would do as part of the act. This interaction also confirmed the reinforce the relationship between patient and doctor, how much can theory that having information regarding the situation helps to promote the design be altered and still represent its symbolic meaning or is there trust amongst participants. It had been my intention to shoot one something else that can act in the same way?

Figure 20 Trust Fall

25 26 PRODUCT PRECEDENTS INVESTIGATION II INVESTIGATION III

The classic medical lab coat has existed for over 100 years and has to carry equipment or personal belongings. The garment’s construction I collected visual references of various types of uniforms, to form a changed very little during that time. The garment appears almost process is also the same way as it was in the 1900s, the method of cut and visual dictionary. The images articulate meanings through the aesthetic exactly the same as it did when it was first introduced to the medical sew creating a garment using two (2D) dimensional textiles that are cut into properties of uniforms. Grouping the imagery by profession I began to field in the early 1900s. Many professionals in the clinical setting wear shapes and sewn together to create a three dimensional (3D) form. identify similar physicality’s, including colors, trims, accessories, shape a white lab coat, including nurses, lab technicians, and educators. The and style, each adding to the meaning and communicating messages coats look very similar, the length being the only significant change. Sleeves of the lab coat are constructed in a set in method, long in length about the person wearing the uniform. Using the storyboards I further The doctor’s lab coat consists of a number of common features. The with a single underarm seam. The front panels of the garment are attached analyzed and identified various properties of different uniforms that color is always white it is usually mid-thigh to knee in length. Student to the back panels with classic vertical side seams and shoulder seams. could also be attributed to the doctors’ profession. doctors in the USA wear a short coat akin to a .35 Aesthetically, The garment sleeves and body are finished with a stitched hem at the the silhouette of the garment is similar to the classic tailored, men’s bottom edge using an over-lock stitch and single needle stitch or clean blazer or . The shape of the collar is a revere in style, which finish hem. The back panel has a vertical center back seam running from is also synonymous with a men’s formal overcoat or blazer. The collar the neck to the hem. In some garments the center back seam has a slit, has a two-piece construction, which is folded back on itself to sit along which is added to provide additional when walking. the neck edge, which aesthetically frames the neck. The coat is single breasted. It has a button down front and is fastened using a classic button through method. The mechanism usually consists consisting The classic process to manufacture a lab coat of five plastic dyed to match buttons sewn to the base cloth in a single includes a number of steps: line with equal spacing. The edge of the button is placed so that when it is fastened through the buttonhole, the button secures the two fronts together symmetrically, vertically, and horizontally. Base cloth is woven Panels are sewn 01 05 The appearance of lab coats for men and women are almost identical; together to construct however, when the coat is fashioned for the male, the front closing has the garment and care a right side over left side fastening whereas the female version has a labels are sewn into the side seams Figure 22 Visual storyboard of uniforms left over right fastening. This is a systemic and consistent feature in the Construction patterns 02 construction of all garments with front openings, and sometimes this are created Figure 21 Visual storyboard of uniforms feature is the only method to identify if the garment is intended for the male or female. However, sometimes the lab coats on offer for doctors The garment is To gain a greater understanding of uniforms and their associated 06 are unisex in style. In this case the fastening is constructed as the male finished, pressed meanings, I researched uniform aesthetics to examine how symbols are Pattern pieces are laid closing and the fit of the garment is also tailored for a male shaped 03 and packed used to create understanding and communicate messages. I collated a body, which is more cylindrical thus less fitted and less flattering on a on the cloth list of attributes associated with the doctors’ profession to see how these female shape. This exaggerates the ill fitting appearance which in turns could be physically represented through the uniform. looks untidy and unflattering. Quality assurance Garment panels 07 Attributes 04 checks happen In general, lab coats share a similar set of traits, including one chest are cut patch pocket placed on the left hand side as worn, which serves as a periodically Professional, educated, wise, powerful, competent, trustworthy, placeholder for a pen and or a hospital identification badge required by throughout the hygienic, approachable, clinical, authoritative, empathic, responsible, all medical staff. This badge is a source of contention due to its location, production process respectful and precise. and its potential as a source of contamination due to the frequent handling and thus its’ susceptibility to contamination, each time it is Many professions have qualities that can be productively compared with removed and applied to the freshly laundered lab coat. There are two the medical profession, including the military, clergy, pilot, airhostess, larger front pockets on the lower part of the garment to allow the wearer police, educators, superheroes and athletes. To visualize the findings, Figure 23 Visual storyboard of uniforms

29 30 Figure 24 Visual storyboard of uniforms

Figure 25 Visual storyboard of uniforms Figure 26 Visual storyboard of uniforms The aim of this investigation is to understand if garment details could wings, jewelry, elaborate metallic embroideries and . Uniform colors be used in an abstracted way to portray similar meanings in a different predominately consisted of combinations with black or navy or red type of garment. To do this I selected a number of details that could be and white. Other common styling details included stripes, piping, gold extracted and used as inspiration for an experiment to examine whether accents, bright color pops, body conscious silhouettes, stitching detail, design details alone could provide meaning to a garment. Some features exaggerated seaming, , technological looking fabrics and quilting. were consistent across multiple groups. Rank, position, authority, power These details were consistent, indicating the likelihood of consistent and hierarchy, are often represented by gold braid, epaulettes, gold themes within garments for physicians. accessories, special pins, badges, multiple stripes, colored tapes, stars, Figure 27 Extrapolated images of significant detailing of uniforms

31 32 INVESTIGATION IV

Figure 29 Prototype development of concepts with design details on T-shirts Figure 30 Prototype development of concepts with design details on T-shirts

Using the nine prototypes, I created an installation and invited an they would represent had been lost in translation between the base audience of VCUQatar professors, visiting lecturer Alice Twemlowe and garment and the abstracted details. On the other hand, this experiment Figure 28 Initial concept sketches highlight design details on T-shirts VCUQatar students to attend a focus group to examine the samples and extended the data collected through secondary research and helped The selected styling details are significant commonalities in a variety details would be understood on another type of garment. write adjectives they felt described the meaning of the details for each me understand the importance of context in understanding meaning. A of uniforms. Taking these details as a starting point I began sketching After a period of one week and multiple iterations of the t-shirts, I settled T-. I did not explain the concept or research to the audience prior uniform is only part of the whole, for the uniform to have true meaning ideas for t-shirts. The first set of sketches appeared obvious and literal on nine concepts to develop into prototypes taking each detail and to the exercise. This installation created an exciting interaction from the environment surrounding it, with the person wearing it and the so I developed further ideas. In order to understand the meaning of deciding on materials, trims, manufacture methods to create the details the participants yet their comments also indicated a strong feeling was behavior of that person all contribute to the meaning of the uniform. All the symbols I abstracted styling details from traditional uniforms and on the T-shirts. one of confusion. The comments heralded a number of adjectives yet of these components must work in tandem to present an image that is applied them to white t-shirts to investigate whether the meaning of the these comments did not have the desired effect in terms of symbolic understood by society. representation as norms for understanding. The meanings I had hoped

33 34 INVESTIGATION V

Industry standard regulations set by organizations including the Doctor Manal, a psychiatrist at Al Ahli hospital in Doha, explained that Food and Drug Administration (FDA) in the USA and the European she is unhappy with the lab coats provided for her by the hospital. She Textile Services Association (ETSA) have not specified the use of observed that the fit is not flattering or suitable for her shape, the lab antimicrobial or other valuable textile properties that could enhance coat sleeves are too long, the shoulders are too wide and she does the performance of medical uniforms making them safer for the not like the fabric. To compensate for these deficiencies she hires a medical professional and patient. professional tailor to custom make her lab coats, which are specially tailored to fit her.38 She is not the only doctor in Qatar tailoring her own As was explained above, the clinical uniform market is saturated lab coats. In discussion with a local tailor he commented that he has with a number of wholesale offers largely motivated by profit; thus, many doctor clients for whom he tailors lab coats. Interestingly, they Figure 31 Installation of t-shirts to host focus group. Dec. 2013. production costs are kept to a minimum. Garments in most cases provide him with the fabric. I asked to see some and was surprised at just meet the rudimentary requirements of health care professionals, the discrepancies in quality ranging from poor quality which is to clothe them. Little design innovation in terms of function blends to 100% polyester.39 None of these fabrics are antimicrobial. and performance has been applied to these garments, particularly doctor’s uniforms, despite evidence suggesting that medical uniforms Further investigation with the Head of Nursing at Aspire Hospital play a role in the spread of deadly bacteria. On a functional level in in Qatar revealed that uniform pockets are a major source of some cases the uniform physically inhibits the wearer and in essence contamination. He suggested that uniforms should not have pockets. promotes bad behavior. This would prevent the wearer from putting potentially contaminated objects into the pockets and inadvertently cause bacteria to spread. Ben Favret is CEO of Vestagen, a company that has developed This logical suggestion may support the drive for eliminating textile Vestex® technology, a clinically proven antimicrobial textile for contamination by removing an area, which is more likely to harbor medical uniforms. He explained that studies have shown that the bacteria due to its use, but how does this solution match with the common polyester/cotton cloth used in most medical apparel has clinicians’ need for pockets?40 been proven to carry and transmit deadly bacteria. In a presentation regarding the new technology he developed, he asked the audience It is clear that the current medical uniform is not fit for purpose on to imagine a doctor walking from patient to patient wearing a many levels, including health and safety, practicality and comfort. contaminated uniform, where a doctor who is actually compliant The research shows that there are better alternatives possible, which Figure 32 Focus Group, audience participation Simone Muscolino, Alice Twemlowe, Figure 33 Focus Group, audience participation. Dec. 2013. with hand washing unknowingly carries infectious bacteria on his/her could be used in uniforms. However, some of the reasons preventing Diane Derr and Richard Lombard. Dec. 2013. clothes, spreading contamination as he/she carries out daily rounds. widespread production and use of these alternatives include cost Yet only a small minority of manufacturers offer anti microbial constraints and limiting standards in policy. These constraints have, in Main Themes: uniforms to the market.36 essence, stagnated the development of medical uniforms.

Professional Nat Landau is owner of Landau Uniforms, one of the most Medical professionals often wear lab coats that are ill fitting and Athletic recognized medical uniform brands in America. He explained that appear shabby on the wearer. On recent hospital visits carrying out Technological he introduced an antimicrobial offer into his uniform range but found observational research I was particularly struck by the appearance the technology did not perform consistently during testing and of clinician’s lab coats. Many professionals wore coats that did not fit Strength ultimately it proved too risky for him to promote in case of a lawsuit. properly, were usually oversized with rolled up baggy sleeves, pockets Powerful He considered continuing to use the antimicrobial fabric without sagged and the collars were crumpled. In the worst cases the fabric had Authority promotion but this also proved impractical, as he could not justify the greyish tones from over-use and laundering, although they appeared Casual additional cost of the garments to the purchasing companies. As a unhygienic. With this in mind, I realized that both metaphorically and Rank result, he stopped using the antimicrobial fabric.37 physically one size does not fit all, and one solution will not suit all. Sterile Maybe the approach to uniforms should be more so that each

35 36 Figure 34 Professional footballers 1960s Figure 36 Cyclists 1950s

Figure 35 Professional footballers 2013 Figure 37 Cyclist 2012

37 38 Figure 36 Doctor’s clothing 1950 Figure 37 Doctor’s clothing 2014 Figure 40 A&E, Al Ahli Hospital, March 2014.

39 40 ANALYSIS

The medical uniform market is saturated with a number of brands that minimizing patient contact with contaminated, infrequently laundered supply uniforms internationally. Lab coats are offered by all brands. items, but a blanket approach to sleeve length may not be appropriate in There are many styles on offer, each with subtle variations fashion all clinical settings, especially in certain parts of the world. In the Middle detailing in seaming, collar shape, pockets and styling. However, the East, doctors adhering to Islamic dress codes wear long sleeves and it base cloths used to make the garments are predominately the same would be culturally unacceptable for them to engage with patients while and are composed of blend of polyester and cotton in a basic weave, wearing short sleeves. So even though a decision taken by hospital which conforms to the industry standard regulations set for medical administrators to create a policy banning long sleeves may seem wear. Surprisingly these standards have not specified many valuable logical, this policy is likely to be rejected by practitioners and patients in properties that could enhance the performance of the garment by many parts of the world. In my approach, I have examined how can the making it a safer uniform for the medical professional and patient. The long sleeved lab coat be maintained yet address some of the problems textile used to make the garment can be addressed in a number of ways it causes. Below is a list of criteria that the lab coat textile could and to add increased function and performance. In terms of aesthetics, there should achieve: is considerable evidence to support the elimination of long sleeves. This policy was introduced to reduce pathogen cross-transmission by

Recommended Fabric Qualities: Problems with the current market offer:

Figure 41 Nike speed suit enhances athlete’s performance to run faster than running naked Crease resistant Unisex lab coat is unflattering on female form individual has a lab coat that fits perfectly. The system surrounding the of the in one piece, thus offering a number of benefits including Fluid resistant uniform with current mass manufacturing techniques, the procurement eliminating the cost of cut and sew, and actually reducing the amount Oversized ill-fitting lab coat looks sloppy and 42 Soil resistant process, cost implications and logistics cannot seem facilitate this idea of waste in producing the shoe. This technique offers the ability to unprofessional for clinical uniform wearers, yet this is possible in other clothing sectors. change the design very quickly without increasing the production Active barrier protective antimicrobial The trend towards individual service and a bespoke offer is available in cost. In industrial manufacturing 3D modeling, advancements in Stretch Uncomfortable for the wearer many clothing sectors. materials and additive manufacturing or 3D printing, as it is commonly Durable Restrictive ergonomically known, have opened up possibilities for manufacturing in a way not Breathable with wicking properties The sports wear industry is usually the first to offer new innovation in seen since the dramatic change that occurred during the industrial Sleeve length too long 43 Comfortable technical advancements to the consumer. brands such as revolution. New manufacturing techniques challenge the traditional Cuff opening too wide Nike, Addidas, Reebok and Puma invest millions of dollars annually to methods of mass production, enabling products previously unthought- Aesthetically pleasing conduct in-depth research and development into new and innovative of to be created and manufactured using the digital modeling skills Professional looking Body length too long technologies, textiles and manufacturing techniques to constantly of engineers and designers. Product development is changing at a Withstands commercial laundering Button fastening not intuitive for female where right over enhance their products to offer advanced performance unlike the rapid pace. Technological advancements and investment are key to its Non-leaching left fastening is preferred 41 medical wear industry. Nike have developed a side to their business success. The fashion industry on the whole still produces clothing in the Color fast offering consumers the option to customize trainers. The consumer traditional industrial revolution manner and hence the advancements in An ill fitting lab coat does not enhance the professional Class 2 OKEX chooses fabrics, colors and styling details when he/she places an additive manufacturing in clothing are lagging behind other industries. Problems with placer holder of security tags order through an online store. The product is custom made However, given the interest from designers and manufacturers alike, Meets international ETSA standards for medical textiles and delivered within four weeks of placing the order. Advancements these advancements will penetrate the clothing sector when these Varying fits make it difficult to choose the right size in manufacturing capabilities have enabled this to become a reality advancements become more commercially viable, including reducing and digital printing has made it cost effective to produce single items the time and cost to create first prototypes. versus the huge costs associated with screen-printing. are created using engineered knitting techniques that create the upper

41 42 HOSPITAL SYSTEM HEALTHCARE ASSOCIATED INFECTIONS (HAIs) DESIGN PROCESS

The topic of the doctors’ clothing has become part of a large debate Staphylococcus Aureus (MRSA)-contaminated environment have User-centered design, participatory design and contextual design are lab coat at this stage in his career and limited its use to the operating with conflicting ideas on the appropriate attire for the doctor. HAI’s the common and deadly bacteria present on their clothes. Dr. Walsh terms that have been used as descriptions of a process that integrates areas of the hospital, where he wears it to cover his scrubs and keep have intensified the debate over doctors’ clothing. The impact of HAIs compared antimicrobial scrubs made with Vestex® antimicrobial the product user into the design process. Each approach holds as the them from being spattered in blood during operations. He explained that in human and financial terms is severe and measureable. In “Adult technology to regular scrubs with no antimicrobial and confirmed role of the user as central. It is imperative to understand the needs the lab coat was a visible sign of a hierarchy that is in naturally inherent Hospital Stays with Infections Due to Medical Care 2007,” Jennifer that the uniforms made with the antimicrobial technology had a very and wants of the user when designing the product. This user-centric in the medical profession explaining, “patient care by committee does Lucado, et al., indicate that HAIs are a common cause of mortality. significant clinical result proving a 5-log reduction in the quantity of method of designing developed in line with advancements in IT where not work.” Where there is a life and death situation, it is the most In 2002, researchers estimated 1.7 million cases of HAIs in the MRSA present on the clinicians’ clothes. This result highlights the values user-friendly interactive platforms were central to the functionality of senior physician who must make the decision, and the “buck drops USA, resulting in 99,000 deaths. The article highlights many of the of an antimicrobial textile by reducing the amount of contamination the product. If the user could not use or navigate an interface then it with him.” However, Dr Brisseau maintained that he felt the white coat causes of HAIs, focusing on areas related to bloodstream infections present on the textile. Interestingly the study concluded that wearing was useless. This process has evolved to encompass many design could also act as a barrier in communicating because of the symbolic caused by devices, grafts, injections or vaccinations. Following that either type of uniform was not correlated with significant difference disciplines; however, it is costly and time-consuming to conduct and hierarchy it represents and that he did not want to create barriers when research, evidence-based guidelines were issued for reducing many in the presence of bacteria on doctors’ hands. In addition to the evaluate research in this way. Where this process has found success communicating to his staff or patients. Dr Brisseau also explained types of HAIs.44 An investigation, by J. A. Wilson et al., examining adherence of stringent regulations related to hand hygiene (the most is highly specialized clothing sectors including sports and clothing for that patient care is the most important part of his job, and being the significance of uniforms and uniform policy in the prevention and common method of spreading bacteria), Dr. Walsh advocates the use of dangerous activities. Examples include Formula One racecar drivers, fire able to communicate in a way that does not overwhelm the patient control of HAIs, states that they found no evidence to support the antimicrobial textiles in medical uniforms.50 fighters, military uniforms and space research. In the general clothing requires skills to be able to simplify information in an understandable, theory of transfer of microorganisms from uniforms to patients in a market, user research is usually limited to customer focus groups and unintimidating and acceptable way. clinical environment.45 To repeat, Jennifer Lucado et al., and Sabina Fijan et al., argue that carried out post product development to assess the likelihood of the medical equipment and hygiene practices are the predominant factors garments being purchased by the consumer. Criteria for assessment I mentioned how research demonstrates clothing can have an effect However, Sabina Fijan et al., reviews the published literature in HAIs, Perry C. et al., and Stacey Butterfield and Betsy McCaughey are based on personal preference, aesthetic and price. In the case of on cognitive ability and posed the question, what if a doctor’s clothing examining the role hospital textiles play in the spread of HAIs, emphasize the link between textiles and the transfer of bacteria. The uniforms, the customer in often an administrative body or procurement could improve their cognitive ability? Dr. Brisseau paused and remarked focusing on the occurrence of microorganisms on hospital textiles. conclusions of these studies are extremely useful because they indicate department unrelated to the user and the purchasing criteria in this case that the WCC could have this impact on a newly qualified doctor with The body of the reports summarized by Fijan, et al focus on hospital that many different areas of the problem need to be addressed, including is most often based on the bottom line cost to the institution. little experience by helping them to look, and subsequently feel, like a , concluding that there is clear evidence that linens carry hygiene policies and procedures, medical equipment and medical doctor. He suggested it is possible this process could support the new microorganisms which can lead to outbreaks of HAI’s. The reports textiles, including linens and uniforms, to understand the problems Of significance to the current research is that medical uniform design physician in carrying out her or his duties as a doctor. Dr. Brisseau’s further conclude that the main causes for contamination include and determine solutions. Consequently, it is highly unlikely that just typically lacks the user’s input. Sidra Hospital has now appointed a comments offer anecdotal support for the literature, which indicated that improper laundering and handling of .46 Adding to this one solution can solve the many problems associated with doctors’ number of clinical leadership teams and I obtained an interview with Dr. the most senior doctors did not wear a lab coat because, after having evidence, C. Perry et al., in a study examining hospital uniforms, attire. Different settings and contexts require different solutions. This Guy Brisseau, the clinical chief of Pediatrics.51 Dr. Brisseau is a pediatric worked in the profession so long they do not feel the need for a uniform confirm the presence of microorganisms on nurses’ uniforms before is not only reflected in the doctor’s uniform but the doctor’s manner doctor at the of his profession and our discussion confirmed most to symbolize their role as a doctor to themselves or others. In addition and after a working shift.47 and surroundings. The patients’ psychological well-being is now of the information I gained through secondary research. I met with Dr. to Dr. Brisseau’s perception of the lab coat, I also wanted to discuss recognized as an important factor in recovering from illness, therefore Brisseau on the executive floor of their administration offices because some of the more tangible aspects of the clothing including questions Adding to the above literature, Stacey Butterfield48 and Betsy the total hospital experience must be considered when taking care of the hospital is currently under construction. Informed by my background regarding the textiles role in transfer of infection. From here ensued a McCaughey49 in separate articles, examine the link between a patients. This concept is reflected in modern hospitals where communal research for this project and my previous experience, I arrived with a lively discussion regarding the topic. serious HAI named Clostridium Difficile (C. diff) and medical uniforms. spaces, colors, pattern, interiors and aesthetic of the surroundings are set of questions that I had hoped to ask him regarding his preferences Interestingly, the reports show the relationship between the lack of specifically designed as an integral component to support patients. and opinions on doctors’ uniforms. One of the first things I wanted to The extent to which textiles play a role in the spread of HAIs is not fully good practice when laundering and changing uniforms and the spread understand was his perception of the lab coat and how he felt receiving it understood, but there is considerable evidence to show textiles are a of the invisible bacteria through the textile. This research highlights the when graduating as a doctor. Based on my research I had assumed that part of the cross-contamination process. In our discussion, Dr. Brisseau reasons that textiles become contaminated and to address the problem he would discuss is as a moment of pride and recognition of entering the explained that unless the research clearly indicated an actual patient would require a multi facetted approach including changing behavior medical profession, but in fact he explained that he graduated in Canada benefithe would not consider making a decision to adopt antimicrobial and policy to offer a solution. where the WCC is not common, and that the white coat for him meant textiles in hospital uniforms. He explained that for the research to be very little. He said that receiving his beeper meant something far more accepted by clinicians, they require scientific proof under the medical Dr. Thomas Walsh conducted a large-scale, four-month clinical-wearer significant to him and wholly represented the responsibility he now had Gold Standard with a randomized double blind study, which is the most trial of doctors’ scrubs in the Medical College of Virginia, Richmond of being a doctor on call. Dr. Brisseau explained that he rarely wore the rigorous form of testing and used by the pharmaceutical industry when and found that 80% of doctors working in a Methicillin-resistant

45 46 ENCLOTHED AND COGNITION

approving drugs to counteract possibilities for bias in testing. Even then, contamination but, as a designer, I believe it is important to conduct It has been established that a medical uniform acts on many levels. into a different psychological state.”56 It is clear that clothing can if the anti microbial reduced the level bacteria present on the textile, deeper-level analyses to ensure we are not just accepting the first It provides the wearer with an aesthetic that symbolizes inclusion in affect the wearer as much as the viewer in terms of the doctor-patient Dr. Brisseau suggested that the medical world has super bugs that are idea that comes to mind and in so doing, miss out on better solutions a specific social group, often the hierarchical position of the wearer relationship. Therefore, if the doctor feels he/she looks more like a resistant to antibiotics and that there may be the possibility that by that could be determined through deeper ideation and more within that group, and is simultaneously a piece of clothing that protects doctor, will he/she perform better in the same way an athlete can eliminating the other forms of bacteria, in fact you are creating a prime innovative approaches. the wearer. We have also seen that the multi-billion dollar clothing perform better when he/she feels and looks good and confident in their substrate for the super bugs to survive. We also discussed the hand industry is constantly evolving as some sectors develop and incorporate athletic apparel? Thinking again of Dr. Brisseau’s comments regarding washing exercise, which is recognized by many as the most important I also interviewed Dr Deepak Kaura, the Chair of Radiology at Sidra advancements in technology to enhance clothing performance. This student doctors’ confidence wearing a lab coat, the evidence strongly exercise in sanitation. Dr. Brisseau explained even in clinical trials, where Medical and Research Center (Sidra). Dr. Kaura was passionate is particularly evident in specialist areas for extreme environments indicates that the lab coat has a very important role to play within the doctors know they are being studied, only 85% of the doctors adhere about the topic and had taken a personal interest in the decision- and situations, including the military, fire fighters, space travel and medical world and to society at large, functioning as a tool on many to the exercise. When asked why, he explained that according to the making regarding uniforms for the Sidra staff.53 During our meeting I sportswear. These sectors apply new technologies to develop and levels, including enhancing the behavior of the doctor and acting as a standards necessary, it takes three minutes to wash hands properly to showed Dr. Kaura some of the designs developed for Sidra hospital. advance materials and garment construction, developing new methods signifier to the patient and to society. clean hands effectively and in the case of a doctor who sees 60 patients Reviewing some of the designs together we began to discuss of production to create performance clothing. Martin Lotti, Nike’s global daily that is equal to three hours of hand washing in the day. Physicians some design features in detail, specifically focusing on the nurses’ creative director for the 2012 Olympics, explains how Nike design and are far too busy to be able to allocate three hours each day to hand uniforms. Dr. Kaura immediately pointed out that a concealed engineer sports performance wear place psychology on an equal footing washing. We also discussed whether there was an alternative way to fastening, a feature designed to hide buttons, would not be suitable with technological advances when designing sportswear to improve an sterilize hands that would take less time? Dr. Brisseau suggested UV for this type of uniform. I was surprised and asked him to elaborate. athlete's performance. light as a possible option. Currently sterilization devices and products He explained that if a nurse opened the button with blood on her harnessing the power of UV light are used in hospitals to sterilize fingers the blood would get trapped in the fabric fold, contaminating Underlining the significance of style for results, Lotti reported that Alpine medical equipment thus preventing the spread of bacteria. If the UV light the fabric and that this design feature made it difficult to launder skier Maria Kirkova once told him, "I perform better if I look better." could prove a viable option to replace hand washing, it would eliminate and sterilize. I immediately expressed that this was exactly the type This brings me to question whether a better-looking uniform might also a number of hindrances to doctors such as reducing the time needed to of information we needed at the design development stage of the enhance a physician’s performance?54 Hajo Adam and Adam Galinsky sanitize their hands, eliminate the need for water and eliminate the need project that an insight like that would influence design decisions. He of Northwestern University carried out a study to examine the effect for physicians to roll up sleeves, and thereby contaminating the sleeves was surprised that we had not talked to the clinical team as part of of clothing on cognitive ability. Their research confirmed that when of the lab coat. This was my first experience of interdisciplinary design the design process; however, as has been discussed above, hospital the participants wore a doctor’s lab coat they performed significantly thinking with a doctor. procurement team often manages the decision over uniforms and better in cognitive tasks than they did when wearing other clothing. In the main priorities of the purchasing team and very different from the the same study the group was split, both groups were given white lab In discussion with Doctor David Sigalet, Clinical Chief of Surgery at concerns of the user. coats; however, half the group was told it was a painter’s coat and half Sidra hospital, he mentioned that even though hand washing is the the group was told it was a doctor’s coat. The volunteers who wore a primary method of sterilizing the hands, the long sleeves of most lab Dr. Kaura’s insights highlighted once again how important it is to “doctor’s coat performed better on sustained attention tasks and were coats require physicians to roll up the sleeves before they can wash understand user needs in order to gain an intimate knowledge on better able to discriminate features in nearly similar pages, then those their hands, thus transferring bacteria and other potentially harmful the subject matter. I explained to both doctors that I intended to carry who wore a painter’s coat.”55 Joshua Davis of Barnard College noted contaminants from the physician’s pre-washed hands to the sleeves of out further research and design development on doctors’ uniforms these investigations suggest, “clothing’s symbolic meaning as visual the lab coat. These contaminants remain on the coat after the hands and asked if they would like to participate in the research and design communication, can influence the viewers attributions and the wearer’s are washed and increase the possibility of infection for anyone who process both responded with a resounding yes. behavioral alignment with the role suggested by clothing.” Galinsky also comes into subsequent contact with the physician’s coat until it is conducted tests to evaluate the difference between seeing a doctor’s decontaminated in the laundry. Doctor Sigalet suggested that all lab white coat and wearing it. coats should have short sleeves52 as a way to address this problem. This recommendation ostensibly represents a straightforward solution, an The group wearing the coat showed the greatest improvement in easy fix, but it may also be a superficial fix. Design thinking emphasizes performance. Dr Galinsky explained, “you have to wear the coat, comprehensive and holistic analyses of problems in order to develop see it on your body and feel it on your skin for it to influence your optimal solutions. Short-sleeved physician coats may help prevent psychological processes. Clothes invade the brain, putting the wearer

47 48 DESIGN DESIGN

To realize the applied outcome of my research I investigated numerous and understanding of the patient. Access to the information will allow design methodologies before adopting speculative design. Speculative the doctor to efficiently and accurately treat the patient while giving design is an innovative method of design practice described by the doctor background knowledge of the patient aiding communication Dunne and Raby as a method that aims to open up new discussion in an empathic manner towards the patient. For the patient, the about existing situations. This method can be used to address wicked physician’s uniform will act as an information provider. It will detail the problems by creating a space to discuss and debate alternative ways doctor’s credentials, indicating not only the doctor’s name and security of being.57 To truly understand the lab coat I have taken a holistic view details, but also display the doctor’s professional background including of the world in which the product exists in, even though much of the education, training and experience in the field. All of this is to offer the data I have uncovered reveal limitations at every turn which prevent patient an insight into the doctor, facilitating a situation for a shared the lab coat from reaching its potential as a better performing, safer knowledge and understanding between doctor and patient and vice and more valuable product. As part of the process I used science fiction versa. The information will be visualized on and through the textile of prototyping, future scenario building, or future narrative scenarios, all the garment, which can display data in real time using nanotube carbon names described to imagine and envision the future in a new way.58 fiber and wireless technology.61 The uniform will have chameleon-like This form of prototyping allows the creator to imagine a future reality properties, changing pattern and color depending on the patient or based on real science and technology by looking at emerging patterns situation. White is shown to be the professional choice and the color and trends and using them to create a fictional story that has fictional most understood as a doctor in a clinical setting; however, the fabric creations embedded in the story. Using the specific method of narrative can mimic many patterns and change appearance, for example, when scenarios I created a fictional story involving characters, in this case talking to a child or the child’s parents. Changing from a child friendly I talked about doctors and patients living in a hospital environment pattern to a more conventional white color during consultation with in the future. The advantage of using a story is that characters can parents. Instant access to current and previous patient records ensure engage in behaviors that highlight key aspects of the scenario.59 With a continuity of care from doctor to doctor no matter which medical this story I aim to propose a What If product for a What If medical care professional within the team is attending the patient. The doctor uses the environment. In helping to define the parameters for the products in the lab coat to help explain complicated procedures in a clear and simplified scenario I built on problems facing today’s hospital and caregivers along way to patients using visuals and info graphics. The lab coat offers the with an analysis of the past history of the doctor. Within this narrative ultimate in protection for the doctor and patient using antimicrobial I focused specifically upon the doctor’s lab coat by creating a list of textiles. In addition, the lab coat has embedded sensors that alert the garment properties addressing some of the problems faced by today’s doctor when it becomes contaminated, ensuring the doctor changes doctors. Solutions to the problems are based on combining emerging into a freshly laundered uniform. The uniform will keep record of the technologies, including Nano technology, material science, textile professional’s hand sanitation procedure and communicate when it is development, communication systems, and IT that will enhance the required or has been forgotten. To address some of the issues of hand performance of the doctor’s uniform.60 I also created mood boards to sanitization the scenario proposes a new method of sanitization using visualize the aesthetic, feel and concepts behind the scenarios. UV light which eliminates the hindrance long sleeves currently cause Oderless, sterile, technological, connected, wireless and also proposes a solution that uses less of the earths’ most precious data transfer, embedded, smart, clean, transparent The concept proposes new enhanced functions of the uniform that will natural resource. Figure 42 Mood board, technology improve the patient doctor relationship by acting as a tool over and beyond the current symbolic and functional qualities of the existing The lab coat has the ability to display data and records in real time. The Patients’ rooms will be more sterile as equipment will not move from education, communication and monitoring. Research confirms that in doctor’s lab coat. In the future narrative the uniform acts as a tool information is transmitted wirelessly in an exchange between patient room to room, doors will be automatic opening when those authorized many cases HAIs are transmitted through human error such as improper to aid communication. It becomes a receptor for digital information and doctor using individual smart clothing embedded with sensors.62 to enter are sanitized. All surfaces and textiles used in the patient rooms laundering and non-compliance with hygiene policies. In this scenario, that can be used by the doctor and shared with the patient enabling The smart technology registers patients’ vital signs, eliminating the need will be made from easy to clean antimicrobial Nano technologies. the uniform is designed to promote better behavior on the part of the the doctor to understand not only the complete medical history of for hospital gadgets, which harbor dirt and bacteria. Such gadgets are Beyond the technical performance of the garment and hospital doctor by aiding communication that will enhance the doctor-patient the patient but also aspects of patient’s personal life. It is intended to the cause if the transmission of bacteria. surroundings, the story also focuses on human behavior. Good design relationship and also prompt the doctor to sanitize hands and change communicate knowledge and provide the medic with a holistic view has the ability to positively impact human behavior using engineering, and clean the uniform when contaminated.

51 52 FUTURE SCENARIO I: DR. WHO?

Scene: Doctor on hospital rounds on a maternity ward. covering for Dr. Manal and recalls that this patient is 36 weeks pregnant with twins and under observation because the twins’ showed signs of Characters irregular heartbeats during week 35 of the pregnancy. Checking the Doctor – Male Dr. Tarek Omar records, Dr. Omar happily observes that the twins’ vital signs are normal Patient – Pregnant Female Anna Jenkins this morning for the third day in a row.

Dr. Omar arrives at 7.15am, which is his usual time to begin daily Still scanning Anna’s chart, Dr. Omar sees that this is not her first rounds, checking on his patients from the night before. Walking by the pregnancy. She has a 5-year-old daughter, who will become big nurse’s station, his sleeve flashes, reminding him that he must visit sister to a brother and sister in two weeks’ time following a scheduled Anna Jenkins this morning. As he pauses to recall the details of this Caesarean at 08.00 on April 4th, 2034. What an easy birthday it will be particular patient – he has over 60 patients to attend daily – Dr. Omar to remember. raises his arm to view the textile data display showing Anna’s details and photo. These are strong reminders for the physician, serving as Still using the information provided on this coat sleeve visuals, Dr. Omar a catalyst to jog his memory for even more information. Today he is checks Anna’s pregnancy history right back to 2029 when her daughter

Alana was born, seeing that she encountered no previous complications procedures, and virtual care. Now only critical cases enter hospitals. in pregnancy. Happily, the doctor will be able to send Anna home today to spend the last week of her pregnancy getting ready to welcome the The blue light indicates that his hands and sleeves are sterile and the new arrivals into their family. door opens automatically, allowing Dr. Omar into the patient’s room.

Walking down the corridor to room 08A Dr. Omar’s sleeve flashes again As he walks forward and toward the bed, Dr. Omar greets Anna. The reminding him to sterilize his hands. He extends his hands into the doctor explains the purpose of his visit today as the privacy panel recessed chamber located to the left of the door, where the yellow UV automatically recedes into the wall. Anna is lying with the sheet light automatically fills it; his hands and clothing appear yellow with the covering her protruding belly. reflection of light. This is the first time for Anna to meet Dr. Omar, who is covering for As he waits 10 seconds until the light changes to blue, Dr. Omar is her regular consultant. The doctor asks Anna how she is feeling this reminded of his early days of being a clinician just out of university, morning. Anna squints as the reads the digital display of data on Dr. when water was still used to sterilize hands, making it almost impossible Omar’s chest. With relief she sees that Dr. Omar is a very experienced to adhere to the three minute protocol to clean hands. How did he physician, having studied and worked internationally. Anna also notes ever manage to adhere to it? HAIs (Healthcare Associated Infections) that Dr. Omar is affiliated with a prestigious institution and is a specialist are almost unheard of in a clinical setting nowadays, due to the strict in the treatment of multiple fetus pregnancies, having delivered over implementation of measures to combat infections, which almost 5000 babies during his career. crippled medical care in the early part of his career. These measures have improved medical care expediently by eliminating not only HAIs Dr. Omar glides his hand over the infrared panel to activate the live but also many unnecessary hospital visits and stays through the use digital display of Anna’s scan, which appears instantaneously on automated functions, touch-free surfaces, wireless data, tool-free the shimmering textile surface of the bed sheet, thanks to the CMOS

53 54 FUTURE SCENARIO II: DR. WHO?

Scene: Doctor on hospital rounds on a pediatric ward. at the date – March 25th 2034 – and thinks how time flies as she notices the surgery was carried out 10 days ago. Characters Doctor – Female Dr Jane Israr Scrolling back through Mustafa’s records she notices that Mustafa Patient – 12 year old boy Mustafa was a premature baby who remained in intensive care for 3 weeks post birth but since that time has developed normally with no complications. The test results indicate that everything is clear and Dr. Israr, preoccupied by an emergency case she attended earlier, she anticipates that he will be sending him home today, after one starts her rounds. The soft light display at the nurses’ station reception final observation. gently fills the space as it reflects on the clean surfaces. She stops and raises her arm to look at the digital display on her sleeve. As it comes As she walks down the corridor to the examination room, she into focus, she smiles, seeing the details of her next patient, Mustafa. notices that Mustafa has a Labrador dog at home – that will be a The young boy’s ankle had been fractured in a fall. The surgery was good talking point. complicated and lasted 2 hours longer than anticipated. Dr. Israr looks

sensor with its ability to send 3D images of the womb in real time to Anna’s face relaxes with relief as she hears the news. Dr. Omar asks the data display. The babies bob up and down, totally unaware of this Anna if Isabelle her daughter is looking forward to having a new brother observation. It still makes Dr. Omar smile when he sees the look on a and sister to look after. patient’s face as they the miracle of life. Anna smiles thinking what a change it is going to be for her family. Dr. Omar discusses the twins, pointing to each child’s heart, remarking on the normal heartbeat and explaining that everything looks good.

55 56 BACKGROUND TO THE NARRATIVE

HAI’s Communication

In an effort to eliminate HAIs, the hospital has ensured All data is accessed through digital displays that are that surfaces are flat, so that there are no nooks and either embedded in smart materials or by augmented crannies in which dirt can lodge, and are easy to clean. reality projected on to surfaces within the room.

The data flashes, reminding her to sterilize her hands. Raising them, an inquisitive 12 year old, who is not shy about asking questions. In Everything is automated to avoid the need for anyone to The textile of the uniform digitally displays patients’ data she inserts them into the recessed chamber. At once, the light beams response to his queries, Dr. Israr taps her chest and reveals an animated touch surfaces. and records. a yellow hue before turning blue, indicating that her hands and data display of the bone repair while explaining the details to the child. uniform are sterile. Then her uniform changes color from white to a Mustafa is fascinated as he watches the animation and asks more Hand washing with water has been replaced with UV The textile surface can change appearance in color and yellow gradient, which is deemed less intimidating to children. The questions. A picture speaks a thousand words, thinks Dr. Israr, marveling light to kill bacteria, which also eliminates problems with pattern when necessary depending on the circumstances examination-room door opens automatically where Dr. Israr enters to not for the first time at how true the phrase is. see Mustafa sitting upright, looking sad. long sleeves as it sterilizes the cloth too. of the interaction. She tells Mustafa that he will be discharged today and asks if he is excited about seeing his dog again, telling him she also has a Labrador All medical equipment is contained in each patient’s The lab coat also functions as an information provider for Dr. Israr walks towards her patient and sits opposite him and at eye named Goldie and asking the name of his dog? room nothing moves from one room to another. the patient, by displaying the doctor’s credentials and level. She begins the conversation by asking how he is feeling. Mustafa data relating to their health issues. explains that he is feeling much better. The doctor swipes her hand over Antimicrobial intelligent textiles are used in the uniform. his sleeve and the live scan of the boy’s bone appears on the surface of the textile of the exam . Both observe the display. Mustafa is If contamination occurs, the thread on the fabric The bleeper is replaced by the digital signal on the surface changes color and the data display indicates doctor’s uniform. contamination. Via the uniform’s digital display, the doctor replaces Doctors don’t carry tools, as the lab coat replaces all the the traditional clipboard of patients’ records with digital traditional tools needed by a doctor. The coat functions records. The entire history of the patient can be accessed on a totally new level. in one location.

The stethoscope is replaced with patient sensors that The medical staff badge is replaced with the digital provide continuous real-time data of the patient’s vital display on the doctor’s chest. This shows not only a signs and wirelessly transfer the information to the name and staff number, but also the credentials of the doctor’s digital display. doctor’s training, experience and success.

57 58 DESIGN INNOVATION

Figure 45 Lab coat toile, calico fabric Figure 47 Lab coat toile, calico fabric

Figure 46 Lab coat toile, calico fabric Figure 48 Lab coat toile, calico fabric capabilities of clothing manufacturers while utilizing some tried and tested symbolism of the traditional lab coat maintaining an understandable construction techniques used by sportswear and other clothing sectors. professional look by using garment engineering to create a design that Figure 43 Lab coat toile, calico fabric Figure 44 Lab coat toile, calico fabric is familiar yet new. The design also has an added elastic detail in the The lab coat in the narratives is based on emerging technological visualizing inspiration for styling, silhouettes, details, fabrics and trims. The designed outcome includes streamlined male and female lab coats sleeve that helps to keep the sleeve up when hand washing. The final advancements not currently commercially available in the market. These combined with the research and list of criteria previously defined that have eliminated potentially problematic styling details to reduce prototypes were made using a local tailor who regularly makes lab coats However I decided to create a physical prototype to create an aesthetic (reference page 42). I began the iterative process of designing the lab contamination touch points including buttons, pockets, flaps, fabric folds, for a number of doctors he has as customers. representation of the design. Using garment technology this design coat by sketching shapes, silhouettes, accessories, construction details raw edge seams. The garment has minimal paneling also reducing the addresses some issues relating to problems identified in the research. and then draping muslin fabric on a mannequin to create 3D forms of number of areas to harbor contamination. The design acknowledges the Going back to my roots I followed the classic fashion design process the 2D sketches. When I was happy with the shapes I converted these researching the most up to date trends in fabrics, textile technology, to paper patterns, which were then used to make physical prototypes. color, retail and reviewing the latest catwalk collections from London, The concept design was modified with each new sketch and prototype. New York, Milan and Paris. I collated the research into storyboards The result is a design engineered to accommodate existing production

59 60 EXHIBITION

Figure 50 Video still

Figure 49 Video still The main challenge of the thesis exhibition was how to communicate The exhibition space was carefully curated to represent a doctor’s a lot of research in a static show, which could engage a live audience examination room. I sourced old medical furniture, bed and a in a short amount of time. This required dissecting the research into number of additional paraphernalia from the medical world to create an understandable bites of information to be displayed in a setting installation of a doctor’s examination room. Posters commonly used complementing the research. To do this I focused on a number of key to communicate information in a doctor’s office were hung on the walls aspects to highlight. highlighting key aspects of the research. The installation was designed to create a setting that would enhance the exhibition experience by • Future scenario and narrative of the world and the artifact engaging the audience full senses, literally drawing them into the smell, • Performance and function of the new lab coat sound and look of medical world. • Prototypes • Problems within the healthcare system Figure 51 Video still

61 62 Figure 54-57 Exhibition installation

Figure 52 Dr. Consunji reading comic strip scenario Figure 53 Dr. Consunji viewing the exhibition

To communicate the narrative I created a visual in the form of emphasizing the behaviors of the doctor in the new world. To illustrate sequential art, which illustrates the story in a simple and explanatory the lab coat of the future I utilized video, animation and 3 D modeling manner. The artwork is also used to create a pamphlet in classic to virtually create a prototype. The video highlights the lab coat design medical style to hand out during the thesis exhibition. The brochure features promoting the benefits of the new design. adopts a comic book style illustrating the characters through which the artifact comes alive. The graphics are designed to be informative and provide context to the story in an understandable way Figure 58 Exhibition Opening with Dean Allyson Vanstone Figure 59 Exhibition opening with Dr Rafael J. Consunji, Director HMC Injury Prevention Program

63 64 CONCLUSION

Research indicates that the lab coat, a seemingly simple garment, is benefits for change. In addition, education and awareness programs actually embedded in highly complex social and professional systems would be necessary to communicate the change and secure the buy- that have shaped the resulting product. To change the lab coat requires in from all stakeholders by targeting audiences within the medical a multi-facetted approach through many channels including the user, profession and patient audience by promoting the benefits of the the patient, professional colleagues, society, the producer and the changes. Many medical professionals have stopped wearing the white hospital bureaucracy. This requires changes in policy, protocol, testing, coat for various reasons including personal preference, perceived standards, specifications, manufacturing, laundering, purchasing and symbolism, associated perception with hygiene, physical garment budgets before a new design could be adopted, and even then for limitations and hospital cutbacks. But not wearing the lab coat has also these changes to be accepted the concepts would require effective left a void where the product is still necessary. This thesis presents a communication to consumer and society. Change is difficult to accept concept for doctors’ clothing that builds on the age-old tradition of lab and therefore changing the lab coat radically and in the short term is not coat with its positive associated meanings and attributes by proposing feasible. However, it would be achievable through an interdisciplinary an alternative that can add value for the doctor and the patient while approach, engaging all the above-mentioned stakeholders, promoting positive behaviors in the doctor, enhancing the doctor patient communicating the possibilities, justifying the costs and quantifying the relationship and limiting the spread of HAIs.

Figure 60 Patricia Duignan wearing lab coat prototype

“The doctor-patient relationship has been and remains a key stone of care: the medium in which the data are gathered, diagnoses and plans are made, compliance is accomplished, and healing, patient activation and support are provided” 63

Figure 61 Vestex® technology, polyester/cotton, antimicrobial, medical textile.

65 66 END NOTES

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7 Douse, j, E Derrett-Smith, K Dheda, and J P Dilworth. 2015. “Should 19 Charon, Joel M. 1979. Symbolic Interactionism: An Introduction, an 34 Abdulla, Rabab. VCUQatar Alumni volunteer, Trust Fall experiment, 46 Fijan, Sabina, and Sonja Šostar Turk. 2012. “Hospital Textiles, Doctors Wear White Coats?” Accessed June 16. http://pmj.bmj.com/ Interpretation, an Integration. Prentice-Hall. Doha, Qatar. Sept 2013 Are They a Possible Vehicle for Healthcare-Associated Infections?” content/80/943/284.full. International Journal of Environmental Research and Public Health 9 20 Blumhagen, D. W. 1979. 35 Hall, Lisa. 2014. “What Do Physicians’ White Coat Lengths Mean?” (9): 3330–43. doi:10.3390/ijerph9093330. 8 Douse, 2015. June 24. http://www.empowher.com/community/share/what-do- 21 Yyelland, Dr. Byrad. Director of Liberal Arts and Sciences, VCUQatar, physicians-white-coat-lengths-mean. 47 Höfer, Dirk. 2011. “[How clothing impacts our work. Researchers 9 Menahem, S., and P. Shvartzman. 1998. “Is Our Appearance Interview, 2013. correlate clothing to mental performance].” Kinderkrankenschwester: Important to Our Patients?” Family Practice 15 (5): 391–97. 36 Favret, Ben. CEO Vestagen, New York City, NY. Interview, September Organ Der Sektion Kinderkrankenpflege / Deutsche Gesellschaft Für 22 Joseph, Nathan, and Nicholas Alex. 1972. 2011. Sozialpädiatrie Und Deutsche Gesellschaft Für Kinderheilkunde 30 (5): 10 Cerejo, Joana, and Barbosa Alvaro. 2012. “The Application of Design 185–86. Thinking Methodology on Research Practices: A Mind-Map of Tools 23 Charon, Joel M. 1979. 37 Landau, Nat CEO of Landau Medical Uniforms, New York City, NY. and Methods”, September. http://www.academia.edu/4393033/ Interview, September 2011. 48 Butterfield, Stacey. 2011. “The White Coat of the Future.” Www. The_Application_of_Design_Thinking_Methodology_on_Research_ 24 Blumhagen, D. W. 1979. acphospitalist.org. http://www.acphospitalist.org/archives/2011/08/ Practices_a_Mind-Map_of_Tools_and_Methods. 38 Osman, MD. Manal. Consultant Psychiatrist, Al Ahli Hospital, Doha, infection.htm.

67 68 TABLES OF FIGURES

49 McCaughey, Betsy. 2008. “Hospital Scrubs Are a Germy, 61 “Dor Tal Forecasts the Future with Wearable Predictables App.” Fig. 1 “Stakeholders Mind Map” pencil on paper, 2014. Fig 18 Rabab Abdulla, Margarita Zuinga, volunteer models “Trust Fall”, Deadly Mess”, January 8. http://www.wsj.com/articles/ 2015. Designboom | Architecture & Design Magazine. Accessed June 16. Fig. 2 Eakins, Thomas. “The Gross Clinic”, Oil on canvas, 240 cm × 200 Doha, Qatar. Nov 2013. SB123137245971962641. http://www.designboom.com/technology/dor_tal-forecasts-the-future- cm with-wearable-predictables-app-03-03-2013/. Surgery carried Dr. Samuel out by doctors in black layman’s clothes, Fig 19 Rabab Abdulla and Samia Muhammed Zar, “Trust Fall” volunteer 50 Butterfield, Stacey. 2011. 1875. models, , Doha, Qatar. Nov 2013. 62 Gaurav. 2013. “AiQ’s BioMan Biomonitoring Shirt and Other Fig. 3 Eakins, Thomas. “Agnew Clinic”, Oil on canvas, 2.14 m x 3.0 m 51 Brisseau, MD, Guy. Chief of Pediatrics, Sidra Medical and Research Smart .” September 23. http://www.medgadget. depicting Dr. Agnew in surgery carried out in white clothes, 1889. Fig. 20 Rabab Abdulla and Samia Muhammed Zar, 2013 Center, Doha, Qatar, interview, December 2013. com/2013/09/aiqs-bioman-biomonitoring-shirt-and-other-smart- clothing-technology.html. Fig. 4 “Trust” Mind map, pen on paper, 2014. Fig. 21 Visual research, uniform storyboards, 2013. 52 Sigalet, Lyle, MD. David. Clinical Chief of Surgery, Sidra Medical and Research Center, Doha Qatar. Meeting, March 2012. 63 Lipkin, Mack, Samuel M. Putnam, Aaron Lazare, J. Gregory Carroll, Fig. 5 George Clooney, TV series ER, http://www.vulture.com/2009 Fig 22 Visual research, uniform storyboards, 2013. and Richard M. Frankel, eds. 1995. The Medical Interview. Frontiers of 53 Kaura, MD. Deepak. Chair of Radiology, Sidra Medical and Research Primary Care. New York, NY: Springer New York. http://link.springer. Fig. 6 Patrick Dempsey, TV series Greys Anatomy, http://media.melty.fr Fig 23 Visual research, uniform storyboards, 2013. Center, Doha, Qatar, interview, December 2013. com/10.1007/978-1-4612-2488-4. Fig. 7 Ellen Pompeo, TV series Greys Anatomy, http://media4.s- Fig. 24 Visual research, uniform storyboards, 2013. 54 “Nike Vapor Laser Talon 3D Printed Football Studs.” 2013. nbcnews.com March 4. http://www.dezeen.com/2013/03/04/nike-vapor-laser-talon- Fig 25 Visual research, uniform storyboards, 2013. 3d-printed-football-boot-studs-by-nike/. Fig. 8 Doctor Characters, TV series Grey’s Anatomy http://media4.s- nbcnews.com Fig 26 Visual research, uniform storyboards, 2013. 55 Welds, Kathryn. 2015. “Clothing Influences Thinking and Behavior, Not Just Others’ Perceptions |.” Accessed June 16. http://kathrynwelds. Fig 9 “Trust” Mind map, pen on paper, 2013. Fig. 27 Visual research, uniform storyboards, 2013. com/2013/11/03/clothing-influences-thinking-and-behavior-not-just- others-perceptions/. Fig. 10 “Trust Fall” Sequential storyboards, pencil on paper, 2013. Fig 28 Visual research, uniform storyboards, 2013.

56 Welds, Kathryn. 2015. Fig. 11 “Trust Fall” Sequential storyboards, pencil on paper, 2013. Fig 29 Prototype development of concepts with design details on T-shirts, 2013. 57 Dunne, Anthony, and Fiona Raby. 2013. Speculative Everything: Fig 12 Hadeer Omar, Patricia Duignan “Trust Fall” set Up, photography Design, Fiction, and Social Dreaming. http://www.dunneandraby.co.uk/ studio , VCUQatar, 2013 Fig 30 Prototype development of concepts with design details on content/books/690/0. T-shirts, 2013. Fig 13 Rabab Abdulla, “Trust Fall” VCUQatar Alumni, volunteer, 2013. 58 Johnson, Brian David. 2011. Science Fiction Prototyping: Designing Fig. 31 Installation of T-shirts to host focus group, Dec. 2013. the Future with Science Fiction. 1 edition. San Rafael, Calif.: Morgan & Fig 14 Hadeer Omar “Trust Fall” camera and lighting set up, 2013 Claypool Publishers. Fig 32 Focus Group, audience participation Simone Muscolino, Alice Fig 15 Sheika Al-Mahmoud and Maraym Al-Homaid, “Trust Fall” Twemlowe, Diane Derr and Richard Lombard. Dec. 2013. 59 Cascio, Jamais. 2015. “Futures Thinking: Writing Scenarios | Fast VCUQatar students .and volunteer models, photography studio in Company | Business + Innovation.” Accessed June 16. http://www. VCUQatar 2013. Fig. 33 Focus Group, audience participation. Dec. 2013. fastcompany.com/1560416/futures-thinking-writing-scenarios. Fig 16 Sheika Al-Mahmoud and Maraym Al-Homaid, 2013. Fig. 34 Professional footballers 1960s, http://www.historicalkits.co.uk

60 Zyga Lisa, “Google Glass and Apple iWatch Inspire Carbon Nanotube Fig 17 Sheika Al-Mahmoud and Maraym Al-Homaid, 2013. Fig. 35 Professional footballers 2013, http://www.sportslook.net Fiber Batteries.” http://phys.org/news/2014-05-google-glass-apple- iwatch-carbon.html. 27 May 2014

69 70 BIBLIOGRAPHY

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71 72 i ACRONYMS AND ABBREVIATIONS

Johnson, Brian David. 2011. Science Fiction Prototyping: Designing Picard, Andre. 2012. “Why Do Physicians Wear White Lab Coats?” July BBE Bare Below the Elbow the Future with Science Fiction. 1 edition. San Rafael, Calif.: Morgan & 2. http://www.theglobeandmail.com/life/health-and-fitness/health/ HMC Hamad Medical Corporation Claypool Publishers. why-do-physicians-wear-white-lab-coats/article4384866/. MRSA Methicillin-Resistant Staphylococcus Aureus

Joseph, Nathan, and Nicholas Alex. 1972. “The Uniform: A Sociological Pierrepont Nathalie. 2014. “Brands Invest in ‘New Generation Perspective.” American Journal of Sociology 77 (4): 719–30. of Materials.’” The Business of Fashion. June 3. http://www. Kazory, Amir. 2008. “Physicians, Their Appearance, and the White businessoffashion.com/articles/intelligence/brands-invest-new- Coat.” The American Journal of Medicine 121 (9): 825–28. doi:10.1016/j. generation-materials. amjmed.2008.05.030. Rehman, Shakaib U., Paul J. Nietert, Dennis W. Cope, and Anne ii DEFINITION OF TERMS Lipkin, Mack, Samuel M. Putnam, Aaron Lazare, J. Gregory Carroll, Osborne Kilpatrick. 2005. “What to Wear Today? Effect of Doctor’s and Richard M. Frankel, eds. 1995. The Medical Interview. Frontiers of Attire on the Trust and Confidence of Patients.” The American Journal of Primary Care. New York, NY: Springer New York. http://link.springer. Medicine 118 (11): 1279–86. doi:10.1016/j.amjmed.2005.04.026. com/10.1007/978-1-4612-2488-4. Doctor – is used when referring to a medical doctor Scheffer, Michiel. R. 2012. “In-Depth Assessment of the Situation Lucado, Jennifer, K Paez, R Andrews, and C Steiner. 2007. “Adult of the Textile and Clothing Sector in the EU and Prospects.” http:// HAI’s – Hospital Acquired Infections, serious life threatening infections acquired during hospital stays one of the biggest problems facing medical Hospital Stays with Infections Due to Medical Care.” Yumpu.com. www.hbo-kennisbank.nl/en/record/E54C0875-90A6-40C0- care. https://www.yumpu.com/en/document/view/37326419/adult-hospital- 85B1AC12219DCB80. stays-with-infections-due-to-medical-care-2007-hcup. Mind Map - Designers use mind maps to reduce information into key words and images by creating a visual structure, which shows the big picture Shaw, Kate, and Stephen Timmons. 2010. “Exploring How Nursing of the information. McCaughey, Betsy. 2008. “Hospital Scrubs Are a Germy, Deadly Mess”, Uniforms Influence Self Image and Professional Identity.” Nursing Times January 8. http://www.wsj.com/articles/SB123137245971962641. 106 (10): 21–23. Log Reduction – scientific notation to calculate microorganisms, 5 log is = 99.999% reduction. Menahem, S., and P. Shvartzman. 1998. “Is Our Appearance Important to Our Patients?” Family Practice 15 (5): 391–97. The Economist. 2012. “A Third Industrial Revolution”, April 21. http:// www.economist.com/node/21552901. “Mind Control Theories and Techniques Used by Mass Media.” 2010. July 7. http://www.ascertainthetruth.com/att/index.php/the-media/ Welds, Kathryn. 2015. “Clothing Influences Thinking and Behavior, Not who-controls-the-media/258-mind-control-theories-and-techniques- Just Others’ Perceptions |.” Accessed June 16. http://kathrynwelds. used-by-mass-media. com/2013/11/03/clothing-influences-thinking-and-behavior-not-just- others-perceptions/. “Nike Vapor Laser Talon 3D Printed Football Boot Studs.” 2013. March 4. http://www.dezeen.com/2013/03/04/nike-vapor-laser-talon-3d- Willis-Owen, C. A., P. Subramanian, and D. Houlihan-Burne. 2010. printed-football-boot-studs-by-nike/. “Effects of ‘Bare below the Elbows’ Policy on Hand Contamination of 92 Ownes, Glen. 2014. “Medical Grade Innovations Announces New, Hospital Doctors in a District General Hospital.”, March. http://www.ncbi. High Performance Scrub Line - Medical Grade Innovations”, October. nlm.nih.gov/pubmed/20299128. http://www.medicalgradeinnovations.com/medical-grade-innovations- announces-new-high-performance-scrub-line/.

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